The Seventh Circuit recently stretched the definition of “referral” under the federal Anti-Kickback Statute (AKS) to affirm a lower court’s ruling that a physician can trigger AKS violations even if such physician does not...more

Congressional Budget Office Estimates Cost of Sustainable Growth Rate Repeal at $174.5 Billion Over Ten Years – The Congressional Budget Office (CBO) recently released an updated estimate of the cost of last year’s bipartisan...more

Reporting Deadline for HIPAA Breaches – March 1, 2015 – Did you have a HIPAA breach this year involving less than 500 individuals? If so, the deadline to report such a breach to the U.S. Department of Health and Human...more

On February 12, 2015, the Centers for Medicare & Medicaid Services (“CMS”) released an updated version of its Medicare Advantage (“MA”) and prescription drug benefit (“Part D”) plan audit protocols and also announced the...more

The Centers for Medicare and Medicaid Services (CMS) had planned to award new contracts to companies that act as Medicare’s recovery audit contractors (now referred to as recovery auditors) (RAs) for operation of the Medicare...more

On Friday, February 20, 2015, CMS released its Advance Notice of Methodological Changes for Calendar Year 2016 for Medicare Advantage (MA) Capitation Rates, Part C and Part D Payment Policies and 2016 Call Letter (the...more

On February 26, 2015, the House Ways and Means Committee is scheduled to vote on the following bills:
H.R. 1021, “Protecting the Integrity of Medicare Act of 2015” – a sweeping bill to promote Medicare program...more

In this issue:
- Document Retention in a Long Term Care Facility
- Medicare RAC Program Improvements Delayed Until 2016
- “Bring Your Own Device” To Work Programs
- NLRB Upends Legality of Employer Email...more

In a recent notice, the Internal Revenue Service has tempered prior guidance that closed the door on employer arrangements for paying the cost of individual health insurance for employees. The IRS still views these premium...more

According to a recent GAO report, CMS has taken numerous steps to prepare industry for the October 1, 2015 transition to ICD-10 codes, such as developing checklists, timelines, and other educational materials and hosting...more

Cancer care is notoriously complex, intensive and costly. With more than 1.6 million people diagnosed with cancer each year, there is a strong impetus towards reforming service delivery. Accordingly, the U.S. Department of...more

On February 13, 2015, CMS announced new audit protocols and process updates for the 2015 Program Audit Cycle for Medicare Advantage (MA) organizations and Part D sponsors. According to the memorandum, 2015 begins a new...more

Rural communities in Kentucky are still largely underserved by health care providers. With the expanded range of Medicaid and Medicare services now available as a result of the Patient Protection and Affordable Care Act...more

Today CMS published a notice correcting its November 10, 2014 final rule updating the Medicare Hospital Outpatient Prospective Payment System (OPPS) and the Ambulatory Surgical Center (ASC) Payment System rates and policies...more

Continuing its focus on so-called “premium reimbursement” or “employer payment plans”, the Internal Revenue Service (IRS) released IRS Notice 2015-17 on February 18, 2015. In this Notice, which was previewed and approved by...more

If you are a physician, most likely, you are not a lawyer. And vice versa. While there are exceptions, generally, the professions of physicians and attorneys are mutually exclusive. Personally, one reason I went to law...more

No one running an ambulance company ever planned to go to prison for doing his or her job. But that is a real possibility if the government knocks on the door, and the owner or manager is dishonest in his or her response to...more

The False Claims Act (FCA) imposes liability on individuals and companies who defraud or submit false claims to the federal government. The FCA allows the federal government to seek treble damages, civil penalties and...more

2014 was a record-breaking year for whistleblowers, including both the U.S. Department of Justice’s prosecution of cases under the False Claims Act (FCA) and the U.S. Securities and Exchange Commission’s prosecution of cases...more

Some employers – particularly smaller ones – have assisted their employees to obtain health insurance by reimbursing them for the cost of insurance they purchase in the individual market. Does this practice satisfy the...more